Advancing nursing practice : redefining the theoretical and practical integration of knowledge

Aim The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. Background The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. Design The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. Method A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. Conclusion There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. Relevance to clinical practice What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner’s work on expert practice. Therefore, if this is included into the knowing-how knowing-that framework, the knowing-how becomes the knowledge that contributes to advancing and advanced practice and the knowing-that becomes the governing action based on a deeper understanding of the problem or issue.

Advancing practice in critical care : a model of knowledge integration

Aim The aim of this paper was to discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. A review of the literature identified that reflective practice appeared to be at the forefront of professional development. Background It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individual’s practice, which then leads onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example, practice development initiatives can be seen as advancing practice for the masses, which ensures that practitioners are following the same level and practice of care. The question here is, are they developing individually? Relevance to clinical practice What this paper presents is that reflection may not be best suited to advancing practice if the individual practitioner does not have a sound knowledge base both theoretically and experientially. The knowledge integration model presented in this study uses multiple learning strategies that are focused in practice to develop practice, e.g. the use of work-based learning and clinical supervision. To demonstrate the models application, an exemplar of an issue from practice shows its relevance from a practical perspective. Conclusions In conclusion, further knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

From expert to tasks, expert nursing practice redefined?

Aim The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. Background Expert nursing practice can be argued to be central to high quality, holistic, individualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the ‘expert nurse’ to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. Method The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. Conclusion Nursing expertise which focuses on the provision of individualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision-making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. Relevance to clinical practice The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise.

The pathophysiology of emphysema : considerations for critical care nursing practice

Emphysema is caused by exposure to cigarette smoking as well as alpha1-antitrypsin deficiency. It has been estimated to cost the National Health Service (NHS) in excess of £800 million per year in related health care costs. The challenges for Critical Care nurses are those associated with dynamic hyperinflation, Auto-PEEP, malnutrition and the weaning from invasive and non-invasive mechanical ventilation. In this paper we consider the impact of the pathophysiology of emphysema, its effects on other body systems as well as the impact acute exacerbations have when patients are admitted to the Intensive Care Unit.

Advancing Nursing Practice in Pain Management

This book showcases the development and evaluation of innovative examples of pain management initiatives by advanced practitioners. It considers each service development or community initiative both in terms of advanced practice nursing and pain management. There is a wide range of examples of innovation in pain management included - from the introduction of ketamine use in one trust, to wider issues around meeting the needs of pain management in the community. The book considers issues including use of research, education and interprofessional working in the advanced practitioner role. Each chapter looks at development of the service, challenges of implementation, evaluation of the service's success and justifying the importance of the advanced nurse in the service's achievements.

Introduction to Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advanced practice The context of pain management: definitions and prevalence Advancing practice in pain management Bringing together advanced practice and pain management Conclusions References

New Knowledge for Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advancing practice in pain management Conclusions References

Circles of care : should community development redefine the practice of palliative care?

Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. The patient centred model of care has limitations when there is a fundamental lack of integrated community policy, development and resourcing. Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.

Statutory right of user - its impact in practice?

Scenario 1 A buys a two storey commercial building built along the only street frontage to the property. Vehicles cannot reach the rear of the property as the building extends across the entire width of the land. A bought the building with full knowledge that vehicular access to the rest of the property had been compromised by a desire to obtain maximum street frontage for the building which was occupied by a commercial tenant. On street parking is scarce in the surrounding area. A (to the knowledge of the adjoining owner B) constructs a carpark at the rear of the building. The employees of A’s tenant have been using the carpark obtaining access via a driveway on B’s land. To formalise this arrangement, A seeks a right of way for vehicles to travel down B’s driveway to access the carpark...

Competition Hertz : the culture and practice of car audio competitions

The present paper explores extreme car audio systems and the culture and practices that surround car audio competitions. I begin by examining whether, and how, car audio can be thought of as a 'music scene' and in what ways the culture and practice of car audio may fit within post-subcultural discourses. Following this, I offer a description of car audio competitions, revealing some of the practices that define this aspect of car audio scenes. In particular, I concentrate on sound pressure level (SPL) competitions and some of the interesting aspects of the SPL scene. Finally, I briefly examine how the powerful effects (and affects) of bass frequencies are an important part of the attraction of loud car audio systems and how car audio systems contribute to the territorializing of urban spaces.

The eighth 48 hour game making challenge (2014)

The 48 hour game making challenge has been running since 2007. In recent years, we have not only been running a 'game jam' for the local community but we have also been exploring the way in which the event itself and the place of the event has the potential to create its own stories. The 2014 challenge is part of a series of data collection opportunities focussed on the game jam itself and the meaning making that the participants engage in about the event. We continued the data collection commenced in 2012: "Game jams are the creative festivals of the game development community and a game jam is very much an event or performance; its stories are those of subjective experience. Participants return year after year and recount personal stories from previous challenges; arrival in the 48hr location typically inspires instances of individual memory and narration more in keeping with those of a music festival or an oft frequented holiday destination. Since its inception, the 48hr has been heavily documented, from the photo-blogging of our first jam and the twitter streams of more recent events to more formal interviews and documentaries (see Anderson, 2012). We have even had our own moments of Gonzo journalism with an on-site press room one year and an ‘embedded’ journalist another year (Keogh, 2011). In the last two years of the 48hr we have started to explore ways and means to collect more abstract data during the event, that is, empirical data about movement and activity. The intent behind this form of data collection was to explore graphic and computer generated visualisations of the event, not for the purpose of formal analysis but in the service of further story telling." [exerpt from truna aka j.turner, Thomas & Owen, 2013) See: truna aka j.turner, Thomas & Owen (2013) Living the indie life: mapping creative teams in a 48 hour game jam and playing with data, Proceedings of the 9th Australasian Conference on Interactive Entertainment, IE'2013, September 30 - October 01 2013, Melbourne, VIC, Australia

Bug reproduction : a collaborative practice within software maintenance activities

Software development settings provide a great opportunity for CSCW researchers to study collaborative work. In this paper, we explore a specific work practice called bug reproduction that is a part of the software bug-fixing process. Bug re-production is a highly collaborative process by which software developers attempt to locally replicate the ‘environment’ within which a bug was originally encountered. Customers, who encounter bugs in their everyday use of systems, play an important role in bug reproduction as they provide useful information to developers, in the form of steps for reproduction, software screenshots, trace logs, and other ways to describe a problem. Bug reproduction, however, poses major hurdles in software maintenance as it is often challenging to replicate the contextual aspects that are at play at the customers’ end. To study the bug reproduction process from a human-centered perspective, we carried out an ethnographic study at a multinational engineering company. Using semi-structured interviews, a questionnaire and half-a-day observation of sixteen software developers working on different software maintenance projects, we studied bug reproduction. In this pa-per, we present a holistic view of bug reproduction practices from a real-world set-ting and discuss implications for designing tools to address the challenges developers face during bug reproduction.

Portrait of the artist as a feminist, practice-led researcher

Becoming a researcher, like any process of cultural initiation, is a complicated negotiation of processes and identity. While it is tempting to imagine that a researcher is just 'one who researches', the reality is far more complex and can be thought of as a journey rather than a sudden change of role. In practice-led research there is often a final and difficult assessment that needs to be made of that journey, and this requires the collation and integration of seemingly schizophrenic elements into one coherent body of findings. This paper attempts to outline the underlying “system of methods used in a particular area of study or activity” that have defined my research journey. It discusses the various elements that have informed and directed this enquiry, which include, but are not limited to: practice-led research, reflexivity, and post/academic writing, all underpinned by a feminist approach.